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elipe
-S
ilva
A
et
al
.
284
R
ev
A
ssoc
M
ed
B
ras
2014; 60(4):284-285
Accreditation
Update on angle-closure glaucoma: diagnosis
A
tualização
em
glaucoma
de
ângulo
fechado
:
diagnóstico
J
air
G
iampani
J
r
, W
anderley
M. B
ernardo
and
R
icardo
S
imões
http://dx.doi.org/10.1590/1806-9282.60.04.0021. What is the importance of gonioscopy in the di-
agnosis of patients with angle-closure glaucoma?
a.
It allows the extension of a given open angle to be es-
tablished.
b.
This is the most relevant examination for the classi-
fication of glaucoma.
c.
Excessive pressure exerted on the lens can reduce the
opening angle of the anterior chamber.
d.
It does not allow differentiation between the apposi-
tion of the iris and the true goniosynechiae.
2. What is the role of UBM (ultrasound biomicros-
copy) in the diagnosis of patients with angle-clo-
suer glaucoma?
a.
The disadvantage is the impossibility of assessing ret-
ro-iridian structures.
b.
The main advantage is the immersion of the ultra-
sound probe.
c.
The apposition of the iris to the outer wall of the ca-
merular sinus has been more frequently detected by
UBM than gonioscopy.
d.
UBM can replace the semi-quantitative analysis of go-
nioscopy.
3. What is the role of AS-OCT (anterior segment op-
tical coherence tomography) in the diagnosis of
patients with angle-closures glaucoma?
a.
The main advantage is the possibility of assessing ret-
ro-iridian structures.
b.
It is the traditional method and reference for the di-
agnosis of angle-closure glaucoma.
c.
AS-OCT does not allow assessment of iris profile.
d.
AS-OCT is useful for quantitative evaluation of the
camerular sinus.
4. Can AS-OCT replace gonioscopy?
a.
The sensitivity of OCT (98%) to detect closed angles
is always greater.
b.
There is greater concordance between the two meth-
ods in detecting closed angles in the upper quadrants.
c.
OCT can replace the semi-quantitative analysis of go-
nioscopy.
d.
The specificity of OCT (98%) to detect closed angles
is always greater.
5. What is the validity of the prone-position test in
dark room in the diagnosis of angle-closure glau-
coma?
a.
Definitive diagnosis of chronic angle-closure glauco-
ma.
b.
Identification of “congestive glaucoma,” with posi-
tivity in 98% of cases.
c.
Checking the probability of angle closure when there
is IOP elevation.
d.
Diagnosis of angle closure, with positivity in 98% of
cases.
A
nswers
to
clinical
scenario
:
update
on
polycystic
kidney
disease
(
hereditary
):
ge
-
netic
diagnosis
and
counseling
[
published
in
2014; 60(3)]
1. In prenatal and neonatal context, is ultrasonog-
raphy sufficient to confirm the clinical diagnosis
of autonomal recessive polycystic kidney disease
(ARPKD)?
Renal ultrasound abnormalities are detectable from
the 13
th
week of pregnancy when the diagnosis was
previously established in an affected sibling. (Alter-
native
D
)
2. In the context of an adult, if the result of the ul-
trasound examination is inconclusive, does the
molecular test allow reaching a definitive conclu-
sion?
The type and position of mutations in the PKHD1
gene provide information about the prognosis of the
disease. (Alternative
C
)
3. Does ultrasound examination allow confirming
the clinical diagnosis of autosomal dominant pol-
ycystic kidney disease. (ADPKD)?
In patients aged 15 to 29 years with 3 or more unilat-
eral or bilateral cysts, the sensitivity is 69.5% and spec-
ificity is 100%. (Alternative
A
)
SCIELO.indb 284
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